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..M <br /> N%wviONITORING WELL INSTALLATION REPtai <br /> Date: '2� ` CONSTRUCTION MVJ <br /> Premise Address: I (A�`� - Total Depth -3 "1 3' 15 <br /> l A Screen Length (from) (to) 6C1 <br /> Well No.: I v`� �`' �As Filter Pack (from) 24 (to) <br /> ^ Bentonite (from) (to) S <br /> Inspector: Grout (from) rz-� (to) _ <br /> Drilling rig typeM <br /> Permit No. Auger O.D. l0" I.D. <br /> II '' <br /> Drilling __�� Completion - Stove pip rstr�boa ircle one) <br /> `Company`: P� 1-� <br /> Driller: It>n casing <br /> IMTheight <br /> Consultant �9-e,0 ' <br /> -Erw-f <br /> 7 <br /> Geologist tc-L-� •- <br /> 9.9 <br /> ABOVE-GROUND CHRZTY43OX <br /> CONFLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Ofout <br /> Domestic well on site - (y/ n ) 5S . ft. <br /> If yes, location and distance - <br /> ft. <br /> m <br /> SAMPLING slotted _ c <br /> secdon <br /> Holding Temperature <br /> Method L _ gravel Pack <br /> Screening Method > <br /> Tracking Sheet - (y/ n ) r <br /> "1 ft. <br /> SPOILS <br /> Storage Method %--IV�`��� MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) fry (� <br /> Storage Location Casing type <br /> Blank �v`2 ft. Screen <br /> Slot size oZs <br /> GROUTING Bags cement <br /> Buckets bentonite : L <br /> Depth to water Bags sand/gravel <br /> Mix Ratios -L Ise o Filter Pack type/size <br /> Installation Method 6 r Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 ��'- <br />